=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659816155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE CROSSING DENTISTRY LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2016
-----------------------------------------------------
Last Update Date | 12/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7133 CENTRAL AVE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-675-3368
-----------------------------------------------------
Fax | 847-675-3362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7133 CENTRAL AVE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-675-3368
-----------------------------------------------------
Fax | 847-675-3362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN E KRAUSS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 847-675-3368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019.019866
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------